Book Review–The Emperor’s New Drugs by: Irving Kirsch

My son went to a new psychiatrist who told him that after prescribing antidepressants for years and also believing that depression, at least in part, is caused by a chemical imbalance, he had decided to do more research. He had come to the conclusion that there was no clear evidence that antidepressants were more clinically effective than placebos! He decided to strongly curtail his prescribing of anti-depressants.

Here is a direct quote from Kirsch: “And yet I remain convinced that the idea of depressions as a chemical imbalance in the brain is a myth.” pg. 4. It was an interesting and controversial hypothesis. I decided to get his book and after reading most of it, he makes an interesting case about pharmaceutical companies perhaps over-exaggerating the effects of SSRI’s over placebos. He makes the case that the difference between the effects of a placebo vs. a drug may be statistically significant, but not clinically significant. “We are faced with a dilemma. Millions of people suffer from depression. Many of them get better when treated with antidepressants, whereas left untreated, they do not show much improvement at all. The problem is that antidepressants have turned out to be not much more effective than placebos.” pg. 149. Rather than dismissing the use of antidepressants completely, I came to some different conclusions!

First, the code for physicians is “do no harm”. So… if an anti-depressant does no harm, even if it has some potentially serious side effects, the risk vs. reward with someone with major depression seems to me to weigh toward using an antidepressant. What this book seems to point to for me is more that depression is such a complex illness. And, there are so many factors that can help a person get better: good sleeping habits, good exercise, good therapy, having a purpose or meaning in life, having good friends and healthy activities. Even a placebo, according to Kirsch has a positive impact on depression. So much of being depressed has to do with mind, body, and spirit: intellectual, physical, and spiritual. Should physicians perhaps prescribe antidepressants more sparingly and recommend other treatments, such as music or art or equine or cognitive behavior therapy or yoga or small group support? I can support many alternate approaches, but to say that antidepressants are not at all effective is a bold and strong statement.

For those who really seem to do better and get relief from an antidepressant, I support use of them. But I also support many of the programs that we refer to that do their best to reduce multiple medications for adolescents and attempt to minimize the use of pharmaceuticals. One day, I hope we have a better ability to understand the role of pharmaceuticals and how they impact the chemistry of the brain.